Yale researchers see ‘exponential’ rise in e-cigarette use among youths

NEW HAVEN >> As the use of electronic cigarettes soars among youth, professor Suchitra Krishnan-Sarin is at the vanguard of research into their effects.

Krishnan-Sarin is co-principal investigator (with professor Stephanie O’Malley) of the Yale Tobacco Center on Regulatory Science, whose particular interest is in flavors and how they alter nicotine addiction. Krishnan-Sarin is also studying the rates of e-cigarette use among youth and young adults in Connecticut, as well as how they are influenced by flavors.

Her research involves 10 middle and high schools in the state. Her investigators are “actually going into the schools and … asking if they use cigarettes. … What are the perceptions” of e-cigs?

“Over the past 2½ years, we have been tracking e-cigarette use in students in Connecticut schools,” she said, finding a “really exponential increase” among young people.

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Her research is in the process of peer review before it can be published, but previous studies show major growth in e-cigarette use rates among high school-age teens.

Krishnan-Sarin said that in two Northeastern high schools, rates of e-cigarette use in a 30-day period went from 0.9 percent in February 2010 to 2.3 percent in June 2011. Rates of having ever used an e-cig went from 2.9 percent to 5.7 percent, she said.

Yale’s is just one of the sites studying different aspects of e-cigarettes for the Food and Drug Administration, which does not regulate e-cigs, although there have been congressional calls for it to do so. “The FDA really doesn’t have any empirical evidence” on how to regulate products like e-cigarettes “so they funded 14 centers all through the United States,” Krishnan-Sarin said. Yale’s center received $20 million over five years to conduct its studies.

The field is wide open, and so is the range of questions about e-cigs, which include disposables, like the brand Blu, and others that can be recharged with nicotine fluid. “They come with these little tanks which are very popular with kids,” Krishnan-Sarin said. All are powered by a battery and emit vapor, not smoke. The research into flavors is just beginning; formal studies began in September.

“The goal of our center is really to understand what flavors are doing in e-cigarettes,” Krishnan-Sarin said. “We are starting out with menthol because that’s one that the FDA has a great interest in.”

Menthol is the only flavor allowed in cigarettes and it is present at some level in all of them. How menthol and nicotine interact in e-cigarettes is one of the questions Yale’s center would like to answer. Research into additional flavors will follow, Krishnan-Sarin said.

Investigators will want to know whether flavors “may alter the effect that people get. … Maybe it makes it less aversive … easier to initiate use,” Krishnan-Sarin said. “One of the claims that the tobacco companies are making is that the presence of flavors … is really just to provide a taste alternative, a choice to smokers,” she said.

“If we find, for example, that menthol doesn’t do anything to tobacco’s effects, then maybe it won’t be banned,” she said. If menthol increases the possibility of addiction or increasing use among young people, “then it is something that the FDA needs to take into consideration.”

In addition to menthol, the center is beginning to study the role of sweeteners in tobacco products, whether “sweeteners alter nicotine’s effects the same way that flavors do, because sweeteners are present in many tobacco products.”

The harshness of tobacco smoke may be a large factor in the popularity of e-cigs because “most people, when they smoke their first cigarette, they don’t like the effect,” Krishnan-Sarin said. “Do flavors do anything? That is what we are trying to get at.”

“The concern that the FDA has and I have is, is use of e-cigarettes going to lead to … a progression of tobacco use behaviors,” or, on the other hand, might they lead to reducing nicotine consumption. People may be using e-cigarettes to quit smoking by reducing the amount of nicotine in the fluid.

But for Krishnan-Sarin, the issue of tobacco vs. e-cigs is not simple. “They don’t contain all the 4,000 chemicals that cigarettes do. However, they do contain glycols and we need to know what else they have.”

Further complicating research, she said, “There are multiple e-cigarettes on the market” and “every one varies. … I don’t think we have a good handle on what goes into an e-cigarette solution.”

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